Safety and efficacy considerations amongst the elderly population in the updated treatment of heart failure: a review

ABSTRACT

Introduction

Heart failure is one of the cardiovascular diseases that impacts the geriatric population. As new clinical trials investigating heart failure are conducted, groundbreaking information is assessable to further evolve the treatment. To correctly improve the quality of life of elderly patients, it is critical to evaluate the safety and efficacy of new and improved therapy regimens.

Areas covered

In reviewal of the 2021 and 2022 updated guidelines, the safety and efficacy of the newly indicated medications will be addressed. The new indications cover sacubitril/valsartan and two SGLT2 inhibitors: dapagliflozin and empagliflozin. An introduction to the medications discussed covers the pharmacology before addressing the efficacy and safety considerations in the elderly population. Furthermore, prime drug-drug interactions associated with the two classes of medications will be considered as well as providing possible solutions to further create the safest drug therapy for geriatric patients with common comorbidities.

Expert Opinion

The two classes of medications, the ARNI and SGLT2 inhibitors, are well-tolerated amongst the elderly population. With the release of new guidelines, the updated medications will provide safer and better therapy in this disease state for geriatrics. One major limitation includes the high cost of these brand-named medications.

KEYWORDS:

• Heart failure
• elderly
• geriatrics guidelines
• safety
• efficacy
• sacubitril/valsartan
• dapagliflozin
• empagliflozin

Article highlights

• The 2021 and 2022 updated guidelines cover the ARNI’s new role in the management of heart failure, while also incorporating the SGLT2 as a new agent for disease management.

• The ARNI and SGLT2 inhibitors offer new mechanistic pathways providing further benefits in the treatment of heart failure.

• Clinical trials reveal the efficacy among elderly patients, with or without diabetes mellitus, for the management of heart failure. The clinical trials range from studying the safety and efficacy of the ARNI and two medications belonging to the SGLT2 inhibitor class, dapagliflozin and empagliflozin.

• The geriatric population has been commonly known as a more medically-sensitive group of people with an increased number of comorbidities to manage. Therefore, parameters to monitor for safety considerations with the use of the ARNI and SGLT2 inhibitors for the treatment of heart failure in the elderly are critical for discussion.

• There are multiple drug-drug interactions that may be more concerning regarding this population, associated with the ARNI and approved SGLT2 inhibitors; thus, we highlight some of the most important interactions while providing possible solutions to improve safety.

• Lastly, these updated guidelines with new medication roles when treating this disease state changed therapy strategies; however, the major drawback continues to be the cost of these medications.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.